Sen. Bernie Sanders wants the Democratic Party to push for providing subsidized health coverage to undocumented immigrants.
But it's uncertain whether the party's platform committee, which is voting on a final platform document Friday, will go along with that position, which is contrary to the position that presumptive Democratic president nominee Hillary Clinton has taken. It would require congressional action to amend the Affordable Care Act, a highly unlikely scenario if Republicans keep control of either chamber of Congress in the November elections.
The Vermont senator's presidential campaign proposed amending the party's draft platform to expand subsidized coverage to undocumented immigrants covered by President Barack Obama's two executive orders deferring deportation for people who have been in the U.S. since childhood and for undocumented parents of lawful residents.
Those orders are known as Deferred Action for Childhood Arrivals (DACA) and Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA). Last month, a deadlocked U.S. Supreme Court failed to overturn an appellate court's ruling blocking implementation of DAPA, meaning that order will not take effect during the remainder of the Obama administration. ACA supporters had hoped that a Supreme Court ruling allowing the implementation of DAPA would ease the way for extending subsidized coverage to millions of undocumented residents.
Under political pressure not to use taxpayer money to pay for coverage of undocumented residents, the Democratic authors of the Affordable Care Act explicitly barred undocumented people from buying coverage through the insurance exchanges or receiving Medicaid coverage -- though they can receive free or low-cost care through federally funded community health centers.
On her campaign website, Clinton advocates letting undocumented immigrants buy coverage on the ACA exchanges. But experts say such coverage would be unaffordable to many, if not most, undocumented people without the ACA's premium subsidies. In addition, Clinton's policy statement makes no mention of extending Medicaid coverage to low-income undocumented residents.
It's estimated that in 2014, more than 4 million of the country's 33 million uninsured residents were undocumented immigrants, who create a significant uncompensated care burden for providers. New York, California, Massachusetts and the District of Columbia use their own funds to extend Medicaid to low-income DACA recipients and certain other undocumented people. In May, California extended Medi-Cal coverage to about 170,000 undocumented immigrant children, at a projected annual cost of $132 million.
In 2010, the Center for Immigration Studies, a conservative group in favor of reducing immigration, estimated that 3.1 million undocumented immigrants who were uninsured would qualify for Medicaid under the ACA, and that it would cost taxpayers $8.1 billion a year to cover them under the program. The center noted, however, that because of their relatively young age and generally good health, the average per capita cost of covering this population would be about half the cost of covering the existing Medicaid population.
It makes sense to help undocumented immigrants obtain affordable coverage because now they have to seek care in expensive hospital emergency departments or delay needed care, leading to higher costs down the line, said Amy Shefrin, a program officer at the New York State Health Foundation. A uniform federal policy would be valuable because it's currently complex and confusing for undocumented immigrants to enroll in state programs. For example, DACA recipients in New York who are on state-funded Medicaid are barred from purchasing a private health plan on the state insurance exchange if their income increases and they are no longer eligible for Medicaid, she added.
Last fall, Rep. Luis Gutierrez (D-Ill.) introduced a bill in Congress that would extend the premium subsidies and the mandate to obtain health coverage to undocumented immigrants. He argued this would help create a younger, healthier insurance risk pool and reduce premiums for everyone.
But Harold Pollack, a health policy expert at the University of Chicago who supports the ACA, opposes extending subsidized exchange coverage to undocumented immigrants without making them full ACA participants. In a March article, he cautioned that without subjecting them to the full range of ACA provisions, including the individual mandate to purchase coverage, just giving them subsidies could encourage sicker people to sign up, further skewing the ACA risk pools.
He backed Clinton's position in favor of letting undocumented immigrants buy unsubsidized coverage while working to establish a path to legalization and citizenship for this population.
“Most Americans oppose the provision of subsidized health coverage to millions of foreigners who might be living here illegally,” Pollack wrote. “Liberal as I am, I can't say I blame the American electorate… There is only one real way to address the problem: Comprehensive immigration reform.”